Carter Mecher had only ever wanted to be a doctor. He’d grown up in a big, working-class family in Chicago where his toolmaker father had encouraged him to tackle problems with the same confidence that he shaped steel.
Carter’s mind would lock into a problem in the same way it did when he was fixing a car engine. That was when he was at his best.
An inability to pay attention to anything except that which you find totally riveting might not sound the most promising trait in a medical student. But almost by process of elimination, it led Carter to his calling: critical care.
From the moment he walked into an intensive care unit, he sensed it was where he was meant to be.
If you didn’t allow yourself to become numb, the place kept you alive to the complexity of life, and its sanctity.
In October 2005, the US government wanted someone who could think ‘outside the box’ to join a small team devoted to pandemic planning. To staff at the Department of Veterans’ Affairs, one name came to mind: their colleague Carter Mecher.
From the moment he walked into an intensive care unit, he sensed it was where he was meant to be. (Stock image)
He was surprised by the call from the White House, and even more surprised by what they wanted him to do.
Carter had learned a lot about infectious disease by treating it in various intensive care units. Yet he knew nothing about pandemics.
‘But it was the White House calling,’ he said. ‘I figured, ‘Yeah, yeah, what the hell.’ ‘
The pandemic planning team had been set up in the wake of President George W.
Bush’s 2005 summer holiday reading – The Great Influenza, a book by historian John Barry about the 1918 flu pandemic.
Bush was determined that America would be better prepared next time there was a major virus outbreak. He demanded to see his government’s sketchy pandemic plan – and immediately dismissed it as ‘bulls**t’.
After commissioning a report by Rajeev Venkayya, a young doctor in the Department of Homeland Security, Bush went to Congress and got $7.1 billion to spend on pandemic preparedness.
RAJEEV said: ‘The US took this on as a national priority before anyone else. We invented pandemic planning.’
Rajeev, Carter and five others set up their base in Washington.
The solution would be a layering of multiple strategies – like the way you lay slices of Swiss cheese on a sandwich, so that the holes don’t align.
Carter had no formal training in epidemiology, but he had a nose for data, an ability to squeeze meaning from it and a gift for quickly figuring out what to do in a crisis.
He was always the first to identify, and make sense of, a new infectious outbreak.
When not in Washington, his emails were typed from a desk just off his bedroom. Quite possibly in his underpants.
For more than a decade, these seven doctors came together behind the scenes each time the world faced a biological threat.
In flurries of phone calls and emails, they sought to figure out what was going on and decide what each of the group might do to save lives.
‘Most of our calls start with: ‘Carter, what are you thinking?’ said Duane Caneva, who, in January last year, was chief medical officer of the US Department of Homeland Security. ‘He’s like a savant on all this stuff.’
WOLVERETTE: Dr Charity Dean, California’s deputy head of public health
Sure enough, it was Carter who first mentioned the existence of coronavirus in Wuhan in an email to colleague Richard Hatchett on January 9 last year.
Just days later, their colleague James Lawler, a Navy doctor who ran the Global Center for Health Security at the University of Nebraska, wrote to the others, asking: ‘Is it likely that the virus outbreak was much larger than what we are seeing?’
The team had a nickname – the Wolverines, after the resistance group in the 1980s dystopian Cold War film Red Dawn, in which the Soviets successfully invade the US.
With the Wolverine approach, you don’t worry about finding the perfect answer. There might never be a perfect answer.
To this day, no one knows how many people in Wuhan were infected on January 18, 2020. But the calculation made by the Wolverines was more or less correct.
And, most crucially, it allowed them to be able to act.
The next day, the first American tested positive for Covid-19, a man who had flown from Wuhan to Seattle. ‘It’s one person coming in from China, we have it under control,’ said President Donald Trump. ‘It’s going to be just fine.’
Fast-forward to February this year and 450,000 Americans are dead from Covid-19. With four per cent of the world population, the US has suffered 20 per cent of coronavirus deaths.
The Lancet said that if the Covid death rate suffered in the US had tracked the average of other G7 nations, 180,000 Americans would still be alive.
So what went wrong?
During the Obama administration, the biodefence team had been dissolved because a false sense of confidence had been created with the containment of an outbreak of swine flu in 2009.
Yet the Wolverines kept in touch. Indeed, Carter Mecher and Richard Hatchett never really stopped working together.
With Trump’s election as president, his national security adviser, John Bolton, believed that the only serious threat to the American way of life was from other nation states.
The Bush and Obama administrations’ concern with natural disasters or disease was banished.
‘In a world of limited resources, you have to pick and choose,’ an anonymous White House source told The Washington Post.
For three years, the Trump administration got lucky. And then their luck ran out.
The US had some of the best scientists in the world – but it had ignored them.
Meanwhile, from his desk at home in Georgia, Carter Mecher collected information, cutting and pasting Chinese reports into Google Translate to make sense of them.
From newspaper obituaries, he gleaned that people were dying much earlier than the Beijing government had admitted. Furthermore, the Chinese had reported only a handful of cases but were behaving as if there had been many more.
‘Reading tea leaves, I see that China is building a 1,000-bed quarantine hospital in Wuhan – in five days. They also called in the military to assist… Reminds me of the military called in to Chernobyl,’ he said.
All the Wolverines chipped in. Carter accepted that no one would have a full, clear picture of the speed at which Covid might spread until it was too late, and he set out to generate as many partial, fuzzy ones as he could.
His approach was a peculiar combination of analysis and analogies – ‘the equivalent of deductive wormholes that take me very quickly from A to B’.
In effect, he was asking which known virus did Covid most closely resemble? The obvious answer was its closest genetic relative, the SARS bug of 2003.
Carter worked all night on a spreadsheet that showed Covid spreading much more quickly than SARS and eliciting very different behaviour from the Chinese government than in 2003 – with Wuhan being quarantined on January 23, 2020.
On January 24, America had its second case, a woman who had also travelled from Wuhan. A day later, China reported 2,298 cases – up from 446 four days earlier.
‘Epidemics don’t behave like this,’ Carter wrote to his fellow Wolverines. The newly infected did not quintuple in five days.
He noted that another giant 1,300-bed hospital had been built in Wuhan. The death of a prominent doctor in the city suggested even people in protective gear could be infected.
Carter found another article, about a Chinese man identified as the source of the infection in several others who had himself experienced no symptoms. If true, cases were going undetected. Warning lights were flashing that explained why the Chinese government was acting so quickly.
What Carter couldn’t understand was why the US government lacked the same urgency. He quickly realised he had to widen his model beyond SARS, and that the new virus would infect, and kill, vastly more people than SARS.
‘Yesterday [January 26] we had 2,700 cases and 80 deaths,’ wrote Carter. ‘Let’s assume the real number of cases is 18 to 40 times greater, or 48,600 to 108,000.’
Assuming the disease takes two weeks to kill, he calculated how many cases there would have been two weeks earlier. This allowed him to crudely estimate the fatality rate at 0.3 to 1.5 per cent.
Carter was under no illusion he was engaged in scholarship. He was simply trying to learn enough to make informed judgments, such as whether, in his role as medical adviser to the Department of Veterans’ Affairs, to prepare the nation’s largest hospital system for an onslaught.
Other Wolverines had decisions to make, too.
Matt Hepburn, who’d spent the previous decade working on vaccine development at the Defense Advanced Research Projects Agency, needed the group’s collective wisdom to decide whether to go all-in for a coronavirus cure.
Richard Hatchett had moved to London in 2017 to run the Coalition for Epidemic Preparedness Innovations (CEPI) which was funded by European governments, the Gates Foundation and others.
Richard had the power to direct hundreds of millions of dollars to companies with new ideas about how to make vaccines more quickly. He noted that the free market had no interest in funding these companies in their early stages.
Matt Hepburn’s unit inside the US Department of Defense had provided some funding for most of these firms but now CEPI was able to help them speed their vaccines through trials.
They’d identified the Boston outfit Moderna, a British-Swedish one called AstraZeneca, and several others as promising candidates. The sooner CEPI’s money went out the door, the sooner any pandemic would end.
Four days earlier, just after Carter generated his first view of the virus, CEPI had made a grant to Moderna to cover costs of the first two stages of clinical trials.
‘I was getting a hell of a lot of heat inside CEPI,’ recalled Richard, who was under pressure for the money not to be wasted.
Carter believed the team’s decisions should be approached in the way an intensive care unit doctor treats a patient clinging to life. The over-riding principle being: if you are wrong, which decision will cause you the greatest regret?
His rough-and-ready calculations suggested that, unchecked, Covid-19 would kill between 900,000 and 1.8 million Americans. ‘I’m certainly no public health expert,’ advised Carter, ‘but no matter how I look at this, it looks bad.’
Richard agreed and never looked back. CEPI gave more than $1 billion to various vaccine manufacturers.
Under the pandemic plan that the Wolverines had drawn up 14 years previously, such an outbreak would be ranked a ‘Category 5’ event and require the federal government to implement a full suite of measures: isolate the ill, cancel all public gatherings, encourage working from home, enforce social distancing and close schools.
But so far as Carter could tell, the Trump administration wasn’t even keeping track of the virus.
He tried to get messages to Trump, but no one in the White House wanted to hear the word ‘pandemic’. ‘We were going nuts,’ he said.
In desperation, each Wolverine sought to identify and contact people with influence.
Rajeev Venkayya had been at medical school with the director of the Ohio Department of Health. Other Wolverines knew the governors of Maryland and Nebraska. Matt Hepburn knew people at the top of the Department of Defense.
They all knew Bob Kadlec, head of the Office of the Assistant Secretary for Preparedness and Response, who had named them the Wolverines during the Bush administration.
The aim was to find at least one state to take the lead and roll out an aggressive response to the virus, introduce the social interventions outlined in the pandemic plan and create a domino effect.
They targeted Dr Charity Dean, California’s deputy head of public health. Wolverine Duane Caneva told her that he was part of a small, almost secret group of doctors, working without the White House’s permission to co-ordinate a national pandemic response.
He needed her help to get a message to the governor of the US’s most populous state so that it might take the lead for the country, as the White House clearly was not going to.
Charity devoured the string of emails Duane had forwarded ‘like a starving person’.
The Wolverines had picked the right woman.
Charity had also been following events in Wuhan and she, too, had made rough calculations from limited information, plotting the likely spread of the disease on the whiteboard in her office.
‘The numbers seemed nuts to me,’ she said.
By June, if the US government did nothing, 20 million Californians would be infected, two million hospitalised, 100,000 dead. However, her boss didn’t want to know, and even banned her from using the word ‘pandemic’.
Nevertheless, she sent out a preparedness survey to California’s hospitals, looked into the capacity of morgues and thought about the need to establish mass graves.
Reading the email chain she had been sent, one Wolverine stood out. ‘They clearly thought this guy Carter was the guru,’ she said.
She read echoes of her own thoughts and, just weeks before, she’d printed out his paper on social distancing and stuck it in a binder – her ‘nerd bible’.
This contained ammunition for the argument she was being forbidden from making: that the virus had arrived, that it might lead to a pandemic and that if she wanted to prevent a lot of people from dying, she had better start working now. Three days later, Duane asked Charity to join them on a conference call.
‘As soon as Carter started talking, I knew I had found my person,’ she said.
Two-thirds of the way into the call, Charity figured out why she had been invited. If she made the right moves in California, the state might be used to steer the entire country’s response.
She realised, too, that the federal response to Americans returning from China was inept. Many had passed through airports in California without being tested. Now nobody knew where they were.
‘We liked her right away,’ Carter said. ‘She’s a spitfire.’ Another began to refer to her as ‘Wolverette’.
By some mechanism that Charity never fully understood, the things she said on these calls had real effects.
During one call in mid-February, she railed about the idiocy of the requirement that only Americans in intensive care with a history of travel to China would qualify for a Covid test when the disease was already spreading inside the US.
A week later, Carter noted that official policy had been changed, adding: ‘Good job, Charity.’
At one point she asked Wolverine James Lawler: ‘Who exactly is in charge of this pandemic?’
‘Nobody,’ he replied. ‘But if you want to know who is sort of in charge, it’s sort of us.’
The ‘sort of’ was telling. For every day brought fresh evidence of America’s leaders’ unwillingness to act. Every moment could be measured in lives lost. What puzzled Carter most was how people who should have known better downplayed the risk.
Stanford University medical professor John Ioannidis became a sensation on US cable news by claiming the virus posed no real threat and that no more than 10,000 Americans would die. The professor condemned social distancing as a hysterical over-reaction.
Meanwhile, Charity, who knew the story would only end with a vaccine or herd immunity, had found an important audience.
In early March, she was laying out her ideas during a joint call about what every state should do, when a new voice came on the line.
It was Ken Cuccinelli, acting deputy secretary of Homeland Security and a member of Trump’s coronavirus taskforce. He said: ‘Charity, you need to push these things through. You’re the only one who can do this.’
She was taken aback by his insistence. ‘He wasn’t pleading with me to do the right thing. He was yelling at me. He was basically implying that the White House is not going to do the right thing. The White House is not going to protect the country. So California needs to take the lead.’
That was the moment she learned that the White House was listening in on the Wolverines’ calls – and also the moment when she realised just how lost and desperate the people at the top were.
Technology entrepreneur Todd Park told Charity that he had noticed a pattern that he’d first identified in the private sector: in any large organisation, the solution to any crisis was usually found not in the officially important people at the top but in some obscure employee six layers down from the people in charge.
A system was groping towards a solution, but the solution required someone in it to be brave, and the system didn’t reward bravery.
In late March 2020, Charity made a note in her journal: ‘One million excess deaths by May 31, 2021.’ Nothing had happened to change her view in June.
Then she had a list of unanswered questions. Maybe the biggest was: Why doesn’t the United States have the institutions it needs to save itself?
Last November, Carter Mecher’s father tested positive for Covid and after a spell in hospital he arranged for him to return home with a supply of oxygen. ‘I don’t want him to die alone,’ he wrote.
But as his father rallied, his mother contracted Covid. Carter wrote: ‘It is hard to fathom all the pain the virus has brought. It is truly a demon from Hell.
I think deep down inside we all sensed this – it was why we tried to get leaders to take early aggressive action to minimise the pain that we knew would come.’
Eighteen days later, his mother died. Carter sat down and wrote a long letter to his family. His theme was gratitude, for the lives they had shared, but his words were suffused with other emotions.
‘Over the past several days, I felt like a balloon that lost all its air,’ he wrote at the end. ‘But I know that with a little time. I will reinflate.’
He was like the surgeon, famously described by a writer, who had inside himself a small cemetery where he buried his failures and, from time to time, went to pray.
And so he went to pray.
Abridged and edited extract from The Premonition: A Pandemic Story, by Michael Lewis, published by Allen Lane at £25. To order a copy for £22.25, including free UK delivery, go to mailshop.co.uk/books or call 020 3308 9193 before May 23.